Computer-assisted teleoperated surgery systems and methods

ABSTRACT

A computer-assisted teleoperated surgical system includes one or more manipulator devices and other components. A manipulator device includes a first link, a second link coupled to a distal end of the first link, a third link coupled to the second link, and an instrument actuator coupled to the third link. A joint that couples the second link to the first link defines a yaw axis. A joint that couples the third link to the second link defines a pitch axis. The instrument actuator defines an insertion axis. The yaw, pitch, and insertion axes are fixed in relation to each other and intersect at a remote center of motion. The instrument actuator may insert a surgical instrument along the insertion axis roll and may roll the surgical instrument around the insertion axis. The proximal end of the first link may be coupled to a repositionable setup structure, which may optionally be mechanically grounded to an operating room table. A user control unit includes a processor that acts as a controller, and user inputs at the user control unit teleoperated the manipulator device via the controller.

COPYRIGHT NOTICE

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by any-one of the patentdocument or the patent disclosure, as it appears in the Patent andTrademark Office patent file or records, but otherwise reserves allcopyright rights whatsoever.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. Pat. ApplicationNo. 16/340,966 filed on Apr. 10, 2019, which is a National StageApplication under 35 U.S.C. §371 and claims the benefit of InternationalApplication No. PCT/US2017/056990, filed Oct. 17, 2017, which claims thebenefit of priority to U.S. Provisional Pat. Application No. 62/409,625filed Oct. 18, 2016, the disclosures of which are incorporated herein byreference.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable.

BACKGROUND 1. Field of Invention

This disclosure relates to devices and methods for minimally invasivecomputer-assisted teleoperated surgery. For example, this disclosureprovides manipulator devices for a computer-assisted teleoperatedsurgery system.

2. Art

Teleoperated surgical systems (often called “robotic” surgical systemsbecause of the use of robot technology) and other computer-assisteddevices often include one or more instrument manipulators to manipulateinstruments for performing a task at a surgical work site and at leastone manipulator for supporting an image capturing device which capturesimages of the surgical work site. A manipulator arm comprises aplurality of links coupled together by one or more actively controlledjoints. In many embodiments, a plurality of actively controlled jointsmay be provided. The robot arm may also include one or more passivejoints, which are not actively controlled, but which comply withmovement of an actively controlled joint. Such active and passive jointsmay be various types, including revolute or prismatic joints. Thekinematic pose of the manipulator arm and its associated instrument orimage capture device may be determined by the positions of the jointsand knowledge of the structure and coupling of the links and theapplication of known kinematic calculations.

Minimally invasive telesurgical systems for use in surgery are beingdeveloped to increase a surgeon’s dexterity as well as to allow asurgeon to operate on a patient from a remote location. Telesurgery is ageneral term for surgical systems in which the surgeon uses some form ofremote control, e.g., a servomechanism, or the like, to manipulatesurgical instrument movements rather than directly holding and movingthe instruments by hand. In such a telesurgery system, the surgeon isprovided with an image of the surgical site at the remote location.While viewing typically a stereoscopic image of the surgical site thatprovides the illusion of depth on a suitable viewer or display, thesurgeon performs the surgical procedures on the patient by manipulatingmaster control input devices, which in turn control the motion ofcorresponding teleoperated instruments. The teleoperated surgicalinstruments can be inserted through small, minimally invasive surgicalapertures or natural orifices to treat tissues at surgical sites withinthe patient, often avoiding the trauma generally associated withaccessing a surgical worksite by open surgery techniques. Thesecomputer-assisted tele-operated systems can move the working ends (endeffectors) of the surgical instruments with sufficient dexterity toperform quite intricate surgical tasks, often by pivoting shafts of theinstruments at the minimally invasive aperture, sliding of the shaftaxially through the aperture, rotating of the shaft within the aperture,and the like.

SUMMARY

This disclosure provides devices and methods for minimally invasiverobotic surgery using a computer-assisted tele-operated surgery device.For example, this disclosure provides manipulator devices for acomputer-assisted teleoperated surgery system. In some embodiments, themanipulator device includes a first link that couples with a set-upstructure, a second link that is rotatably coupled to the first link,and a third link that is pivotably coupled to the second link. The thirdlink is configured to receive a surgical instrument actuator that can,in turn, receive a surgical instrument. The surgical instrument definesan insertion axis. In some such embodiments, pivoting the third link inrelation to the second link causes a sweeping motion of the insertionaxis that traces a portion of a conical surface. In some suchembodiments, the manipulator device has a hardware-constrained remotecenter of motion (RCM). The RCM is a point in space around which theroll, pitch, and yaw motions of the manipulator device are made. Whenthe manipulator devices are used for minimally invasivecomputer-assisted teleoperated surgery, movement of the manipulatorassembly is constrained to a safe motion through a minimally invasivesurgical access site or other aperture that is substantially coincidentwith the RCM. The motion of the manipulator device will thereby precludeexcessive lateral motion of the body wall access cannula which mightotherwise tear the tissues adjacent the aperture or enlarge the accesssite inadvertently.

In one aspect, this disclosure is directed to a computer-assistedteleoperated surgery manipulator device that includes a first linkconfigured to releasably couple with a set-up structure of acomputer-assisted tele-operated surgery system; a second link rotatablycoupled to the first link such that the second link is rotatable inrelation to the first link about a first axis; and a third linkpivotably coupled to the second link such that the third link ispivotable in relation to the second link about a second axis. The thirdlink is configured to releasably couple with a patient body wall accesscannula defining an insertion axis for a surgical instrument. The firstaxis, the second axis, and the insertion axis consistently intersect ata particular fixed point in space throughout rotation of the second linkin relation to the first link and pivoting of the third link in relationto the second link. Pivoting the third link in relation to the secondlink sweeps the insertion axis to trace a portion of a conical surface.

Such a computer-assisted tele-operated surgery manipulator device mayoptionally include one or more of the following features. The secondlink may include a leadscrew, a motor for rotating the leadscrew, and anut threadably coupled to the leadscrew. The nut may be coupled to alinkage pivotably coupled to the third link at a location spaced apartfrom the second axis. Rotation of the leadscrew may cause the third linkto pivot in relation to the second link. The third link may bereleasably coupleable with a computer-assisted teleoperated surgicalinstrument actuator. The third link may include a motor for drivingrotations of the computer-assisted tele-operated surgical instrumentactuator about the insertion axis. The first link may include a motorthat drives rotations of the second link in relation to the first link.In some embodiments, throughout rotation of the second link in relationto the first link and pivoting of the third link in relation to thesecond link, the second axis may remain non-orthogonal to the insertionaxis. In some embodiments, during surgery using the computer-assistedteleoperated surgery manipulator device and at all positions of thethird link in relation to the second link, the second link may berotated in relation to the first link through an arc of at least 120degrees without contact between the manipulator device and a plane thatincludes the particular fixed point in space. In particular embodiments,during surgery using the computer-assisted tele-operated surgerymanipulator device the first axis may be at an angle of less than 30degrees in relation to the plane that includes the particular fixedpoint in space.

In another aspect, this disclosure is directed to a computer-assistedteleoperated surgery manipulator device including: a first linkconfigured to releasably couple with a set-up structure of acomputer-assisted tele-operated surgery system; a second link rotatablycoupled to the first link such that the second link is rotatable inrelation to the first link about a first axis, the second linkcomprising a leadscrew and a nut threadably coupled to the leadscrew;and a third link pivotably coupled to the second link such that thethird link is pivotable in relation to the second link about a secondaxis. The third link is configured to releasably couple with a patientbody wall access cannula defining an insertion axis for a surgicalinstrument. The first axis, the second axis, and the insertion axisconsistently intersect at a particular fixed point in space throughoutrotation of the second link in relation to the first link and pivotingof the third link in relation to the second link. The nut is coupled toa linkage that is pivotably coupled to the third link at a locationspaced apart from the second axis, and wherein rotation of the leadscrewcauses the third link to pivot in relation to the second link.

Such a computer-assisted teleoperated surgery manipulator device mayoptionally include one or more of the following features. The insertionaxis may trace a portion of a conical surface as the third link ispivoted in relation to the second link. The third link may be releasablycoupleable with a computer-assisted tele-operated surgical instrumentactuator. The third link may include a motor for driving rotations ofthe computer-assisted teleoperated surgical instrument actuator aboutthe insertion axis. The first link may include a motor that drivesrotations of the second link in relation to the first link. Throughoutrotation of the second link in relation to the first link and pivotingof the third link in relation to the second link, the second axis mayremain nonorthogonal to the insertion axis. During surgery using thecomputer-assisted teleoperated surgery manipulator device and at allpositions of the third link in relation to the second link, the secondlink may be rotatable in relation to the first link through an arc of atleast 120 degrees without contact between the manipulator device and aplane that includes the particular fixed point in space. In someembodiments, during surgery using the computer-assisted teleoperatedsurgery manipulator device the first axis is at an angle of less than 30degrees in relation to the plane that includes the particular fixedpoint in space.

In another aspect, this disclosure is directed to a computer-assistedteleoperated surgery system including: a set-up structure releasablycoupleable with a frame; a manipulator device; and a computer-assistedtele-operated surgical instrument actuator releasably coupleable withthe third link. The manipulator device includes: a first link configuredto releasably couple with a set-up structure of a computer-assistedtele-operated surgery system; a second link rotatably coupled to thefirst link such that the second link is rotatable in relation to thefirst link about a first axis; and a third link pivotably coupled to thesecond link such that the third link is pivotable in relation to thesecond link about a second axis. The third link is configured toreleasably couple with a patient body wall access cannula defining aninsertion axis for a surgical instrument. The first axis, the secondaxis, and the insertion axis consistently intersect at a particularfixed point in space throughout rotation of the second link in relationto the first link and pivoting of the third link in relation to thesecond link. Pivoting the third link in relation to the second linksweeps the insertion axis to trace a portion of a conical surface. Thethird link includes a roll-adjustment motor that drives rotation of thesurgical instrument actuator about the insertion axis.

Such a computer-assisted tele-operated surgery system may optionallyinclude one or more of the following features. An entirety of theinstrument actuator can be rotatably drivable by the roll-adjustmentmotor. The system may also include the computer-assisted teleoperatedsurgical instrument receivable by the surgical instrument actuator. Thesecond link may include a leadscrew, a motor for rotating the leadscrew,and a nut threadably coupled to the leadscrew. The nut may be coupled toa linkage that is pivotably coupled to the third link at a locationspaced apart from the second axis. Rotation of the leadscrew causes thethird link to pivot in relation to the second link. In some embodiments,during surgery using the computer-assisted teleoperated surgerymanipulator device and at all positions of the third link in relation tothe second link, the second link may be rotated in relation to the firstlink through an arc of at least 120 degrees without contact between themanipulator device and a plane that includes the particular fixed pointin space.

Some or all of the embodiments described herein may provide one or moreof the following advantages. In some cases, the teleoperated surgicalmanipulator devices provided herein are advantageously structured tohave a low-profile, i.e., to be spatially-compact and/or able to beoriented at a low angle (e.g., in a range of about 15° to about 30°) tothe patient. Such a compact configuration is advantageous in that theworking space occupied by the teleoperated surgical manipulators abovethe patient is minimized, allowing for enhanced patient access by thesurgical team. Additionally, greater visualization of the patient andcommunications between the surgical team members is facilitated by thecompact manipulator working space.

Further, lessening the size of the manipulator working space can reducethe potential for collisions between manipulators. In result, the needfor redundant degrees of freedom of the manipulators is mitigated.Hence, the complexity of the manipulators can be lessened in some cases.

The compact size of the tele-operated surgical manipulator devicesprovided herein can also advantageously facilitate mounting themanipulators to a rail of an operating table in some cases. In such acase, as the operating table is manipulated to enhance surgical access,the table-mounted manipulator devices inherently follow. Therefore, theneed to reposition the manipulators in response to movements of theoperating table is advantageously reduced or eliminated.

In addition, the teleoperated surgical manipulator devices providedherein are advantageously structured to have a relatively low mass andinertia. In addition, the mass distribution is substantially constantsuch that the inertia is substantially constant, and thereforepredictable.

The details of one or more embodiments are set forth in the accompanyingdrawings and the description below. Other features, objects, andadvantages will be apparent from the description and drawings, and fromthe claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an example patient-side cart of acomputer-assisted tele-operated surgery system.

FIG. 2 is a front view of an example surgeon console of acomputer-assisted tele-operated surgery system.

FIG. 3 is a side view of an example robotic manipulator arm assembly ofa computer-assisted tele-operated surgery system.

FIG. 4 is a perspective view of another type of patient-sidecomputer-assisted tele-operated surgery system.

FIG. 5 is a perspective view of a distal end portion of an examplesurgical instrument in a first configuration.

FIG. 6 is a perspective view of the distal end portion of the surgicalinstrument of FIG. 5 in a second configuration.

FIG. 7 is a perspective view of the distal end portion of the surgicalinstrument of FIG. 5 in a third configuration.

FIG. 8 is a perspective view depicting a surgical instrument coupledwith a surgical instrument actuation pod that is mounted to an examplecomputer-assisted teleoperated surgery manipulator device in accordancewith some embodiments.

FIG. 9 is a perspective view of an example surgical instrument actuationpod in accordance with some embodiments.

FIG. 10 is a perspective view of an example computer-assistedteleoperated surgery manipulator device in accordance with someembodiments.

FIG. 11 is another perspective view of the manipulator device of FIG. 10.

FIG. 12 is a top view of the computer-assisted tele-operated surgerymanipulator device of FIG. 10 . The first link of the manipulator deviceis shown transparently.

FIG. 13 is a bottom view of the computer-assisted tele-operated surgerymanipulator device of FIG. 10 with the first link shown transparently.

FIG. 14 is a perspective view of the computer-assisted tele-operatedsurgery manipulator device of FIG. 10 in a first orientation in relationto a body wall.

FIG. 15 is a perspective view of the computer-assisted tele-operatedsurgery manipulator device of FIG. 10 in a second orientation inrelation to the body wall.

FIG. 16 is another perspective view of the computer-assistedteleoperated surgery manipulator device of FIG. 10 . The second link ofthe manipulator device is shown transparently.

FIG. 17 is another perspective view of the computer-assistedteleoperated surgery manipulator device of FIG. 10 with the second linkshown transparently.

FIG. 18 is a perspective view of the computer-assisted tele-operatedsurgery manipulator device of FIG. 10 in a third orientation in relationto the body wall.

FIG. 19 is a perspective view of the computer-assisted tele-operatedsurgery manipulator device of FIG. 10 in a fourth orientation inrelation to the body wall.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

This description and the accompanying drawings that illustrate inventiveaspects, embodiments, implementations, or applications should not betaken as limiting—the claims define the protected invention. Variousmechanical, compositional, structural, electrical, and operationalchanges may be made without departing from the spirit and scope of thisdescription and the claims. In some instances, well-known circuits,structures, or techniques have not been shown or described in detail inorder not to obscure the invention. Like numbers in two or more figuresrepresent the same or similar elements.

Further, specific words chosen to describe one or more embodiments andoptional elements or features are not intended to limit the invention.For example, spatially relative terms—such as “beneath”, “below”,“lower”, “above”, “upper”, “proximal”, “distal”, and the like—may beused to describe one element’s or feature’s relationship to anotherelement or feature as illustrated in the figures. These spatiallyrelative terms are intended to encompass different locations (i.e.,translational placements) and orientations (i.e., rotational placements)of a device in use or operation in addition to the location andorientation shown in the figures. For example, if a device in thefigures is turned over, elements described as “below” or “beneath” otherelements or features would then be “above” or “over” the other elementsor features. Thus, the exemplary term “below” can encompass bothlocations and orientations of above and below. A device may be otherwiseoriented (e.g., rotated 90 degrees or at other orientations) and thespatially relative descriptors used herein interpreted accordingly.Likewise, descriptions of movement along (translation) and around(rotation) various axes includes various special device locations andorientations. The combination of a body’s location and orientationdefine the body’s pose.

Similarly, geometric terms, such as “parallel”, “perpendicular”,“round”, or “square”, are not intended to require absolute mathematicalprecision, unless the context indicates otherwise. Instead, suchgeometric terms allow for variations due to manufacturing or equivalentfunctions. For example, if an element is described as “round” or“generally round”, a component that is not precisely circular (e.g., onethat is slightly oblong or is a many-sided polygon) is still encompassedby this description. The words “including” or “having” mean includingbut not limited to.

It should be understood that although this description is made to besufficiently clear, concise, and exact, scrupulous and exhaustivelinguistic precision is not always possible or desirable, since thedescription should be kept to a reasonable length and skilled readerswill understand background and associated technology. For example,considering a video signal, a skilled reader will understand that anoscilloscope described as displaying the signal does not display thesignal itself but a representation of the signal, and that a videomonitor described as displaying the signal does not display the signalitself but video information the signal carries.

In addition, the singular forms “a”, “an”, and “the” are intended toinclude the plural forms as well, unless the context indicatesotherwise. And, the terms “comprises”, “includes”, “has”, and the likespecify the presence of stated features, steps, operations, elements,and/or components but do not preclude the presence or addition of one ormore other features, steps, operations, elements, components, and/orgroups. And, each of the one or more individual listed items should beconsidered optional unless otherwise stated, so that variouscombinations of items are described without an exhaustive list of eachpossible combination. The auxiliary verb may likewise implies that afeature, step, operation, element, or component is optional.

Elements described in detail with reference to one embodiment,implementation, or application optionally may be included, wheneverpractical, in other embodiments, implementations, or applications inwhich they are not specifically shown or described. For example, if anelement is described in detail with reference to one embodiment and isnot described with reference to a second embodiment, the element maynevertheless be claimed as included in the second embodiment. Thus, toavoid unnecessary repetition in the following description, one or moreelements shown and described in association with one embodiment,implementation, or application may be incorporated into otherembodiments, implementations, or aspects unless specifically describedotherwise, unless the one or more elements would make an embodiment orimplementation non-functional, or unless two or more of the elementsprovide conflicting functions.

Elements described as coupled may be electrically or mechanicallydirectly coupled, or they may be indirectly coupled via one or moreintermediate components.

The term “flexible” in association with a part, such as a mechanicalstructure, component, or component assembly, should be broadlyconstrued. In essence, the term means the part can be repeatedly bentand restored to an original shape without harm to the part. Many “rigid”objects have a slight inherent resilient “bendiness” due to materialproperties, although such objects are not considered “flexible” as theterm is used herein. A flexible part may have infinite degrees offreedom (DOF’s). Examples of such parts include closed, bendable tubes(made from, e.g., NITINOL, polymer, soft rubber, and the like), helicalcoil springs, etc. that can be bent into various simple or compoundcurves, often without significant cross-sectional deformation. Otherflexible parts may approximate such an infinite-DOF part by using aseries of closely spaced components that are similar to a snake-likearrangement of serial “vertebrae.” In such a vertebral arrangement, eachcomponent is a short link in a kinematic chain, and movable mechanicalconstraints (e.g., pin hinge, cup and ball, live hinge, and the like)between each link may allow one (e.g., pitch) or two (e.g., pitch andyaw) DOF’s of relative movement between the links. A short, flexiblepart may serve as, and be modeled as, a single mechanical constraint(joint) that provides one or more DOF’s between two links in a kinematicchain, even though the flexible part itself may be a kinematic chainmade of several coupled links. Knowledgeable persons will understandthat a part’s flexibility may be expressed in terms of its stiffness.

Unless otherwise stated in this description, a flexible part, such as amechanical structure, component, or component assembly, may be eitheractively or passively flexible. An actively flexible part may be bent byusing forces inherently associated with the part itself. For example,one or more tendons may be routed lengthwise along the part and offsetfrom the part’s longitudinal axis, so that tension on the one or moretendons causes the part or a portion of the part to bend. Other ways ofactively bending an actively flexible part include, without limitation,the use of pneumatic or hydraulic power, gears, electroactive polymer(more generally, “artificial muscle”), and the like. A passivelyflexible part is bent by using a force external to the part (e.g., anapplied mechanical or electromagnetic force). A passively flexible partmay remain in its bent shape until bent again, or it may have aninherent characteristic that tends to restore the part to an originalshape. An example of a passively flexible part with inherent stiffnessis a plastic rod or a resilient rubber tube. An actively flexible part,when not actuated by its inherently associated forces, may be passivelyflexible. A single part may be made of one or more actively andpassively flexible parts in series.

An example of a teleoperated surgical system is the da Vinci® SurgicalSystem, commercialized by Intuitive Surgical, Inc. of Sunnyvale,California. Inventive aspects are associated with computer-assistedteleoperated surgical systems. Knowledgeable persons will understandthat inventive aspects disclosed herein may be embodied and implementedin various ways, including computer-assisted and hybrid combinations ofmanual and computer-assisted embodiments and implementations. Asapplicable, inventive aspects may be embodied and implemented in bothrelatively smaller, hand-held, hand-operated devices and relativelylarger systems that have additional mechanical support, as well as inother embodiments of computer-assisted tele-operated medical devices. Inaddition, inventive aspects are associated with advances incomputer-assisted surgical systems that include autonomous rather thanteleoperated actions, and so both teleoperated and autonomous surgicalsystems are included, even though the description concentrates onteleoperated systems.

A computer is a machine that follows programmed instructions to performmathematical or logical functions on input information to produceprocessed output information. A computer includes a logic unit thatperforms the mathematical or logical functions, and memory that storesthe programmed instructions, the input information, and the outputinformation. The term “computer” and similar terms, such as “processor”or “controller”, encompasses both centralized single-location anddistributed implementations.

This disclosure provides improved surgical and telesurgical devices,systems, and methods. The inventive concepts are particularlyadvantageous for use with telesurgical systems in which a plurality ofsurgical tools or instruments are mounted on and moved by an associatedplurality of teleoperated manipulators during a surgical procedure. Theteleoperated surgical systems will often comprise tele-robotic,telesurgical, and/or telepresence systems that include processorsconfigured as master-slave controllers. By providing teleoperatedsurgical systems employing processors appropriately configured to movemanipulator assemblies with articulated linkages having relatively largenumbers of degrees of freedom, the motion of the linkages can betailored for work through a minimally invasive access site. The largenumber of degrees of freedom may also allow a processor to position themanipulators to inhibit interference or collisions between these movingstructures, and the like.

The manipulator assemblies described herein will often include ateleoperated manipulator and a tool mounted thereon (the tool oftencomprising a surgical instrument in surgical versions), although theterm “manipulator assembly” will also encompass the manipulator withoutthe tool mounted thereon. The term “tool” encompasses both general orindustrial robotic tools and specialized robotic surgical instruments,with these later structures often including an end effector that issuitable for manipulation of tissue, treatment of tissue, imaging oftissue, or the like. The tool/manipulator interface will often be aquick disconnect tool holder or coupling, allowing rapid removal andreplacement of the tool with an alternate tool. The manipulator assemblywill often have a base that is fixed in space during at least a portionof a telesurgical procedure, and the manipulator assembly may include anumber of degrees of freedom between the base and an end effector of thetool. Actuation of the end effector (such as opening or closing of thejaws of a gripping device, energizing an electrosurgical paddle, or thelike) will often be separate from, and in addition to, these manipulatorassembly degrees of freedom.

The end effector will typically move in the workspace with between twoand six degrees of freedom. As used herein, the term “position”encompasses both location and orientation. Hence, a change in a positionof an end effector (for example) may involve a translation of the endeffector from a first location to a second location, a rotation of theend effector from a first orientation to a second orientation, or acombination of both. As used herein, the term “end effector” thereforeincludes but is not limited to the function of changing the orientationor position (e.g., a “wrist” function, a parallel motion function) ofits distal-most part or parts (e.g., jaw(s) and the like).

When used for minimally invasive teleoperated surgery, movement of themanipulator assembly may be controlled by a processor of the system sothat a shaft or intermediate portion of the tool or instrument isconstrained to a safe motion through a minimally invasive surgicalaccess site or other aperture. Such motion may include, for example,axial insertion of the shaft through the aperture site, rotation of theshaft about its axis, and pivotal motion of the shaft about a pivotpoint adjacent the access site, but will often preclude excessivelateral motion of the shaft which might otherwise tear the tissuesadjacent the aperture or enlarge the access site inadvertently. Some orall of such constraint on the manipulator motion at the access site maybe imposed using mechanical manipulator joint linkages that inhibitimproper motions, or may in part or in full be imposed using roboticdata processing and control techniques. Hence, such minimally invasiveaperture-constrained motion of the manipulator assembly may employbetween zero and three degrees of freedom of the manipulator assembly.

Many of the exemplary manipulator assemblies described herein will havemore degrees of freedom than are needed to position and move an endeffector within a surgical site. For example, a surgical end effectorthat can be positioned with six degrees of freedom at an internalsurgical site through a minimally invasive aperture may in someembodiments have nine degrees of freedom (six end effector degrees offreedom—three for location, and three for orientation—plus three degreesof freedom to comply with the access site constraints), but will oftenhave ten or more degrees of freedom. Highly configurable manipulatorassemblies having more degrees of freedom than are needed for a givenend effector position can be described as having or providing sufficientdegrees of freedom to allow a range of joint states for an end effectorposition in a workspace. For example, for a given end effector position,the manipulator assembly may occupy (and be driven between) any of arange of alternative manipulator linkage positions. Similarly, for agiven end effector velocity vector, the manipulator assembly may have arange of differing joint movement speeds for the various joints of themanipulator assembly.

Referring to FIGS. 1 and 2 , systems for minimally invasivecomputer-assisted telesurgery (as referred to herein as “minimallyinvasive robotic surgery”) can include a patient-side unit 100 and asurgeon control unit 40. Telesurgery is a general term for surgicalsystems where the surgeon uses some form of remote control, e.g., aservomechanism, or the like, to manipulate surgical instrument movementsby using robot technology rather than directly holding and moving theinstruments by hand. The robotically manipulatable surgical instrumentscan be inserted through small, minimally invasive surgical apertures totreat tissues at surgical sites within the patient, avoiding the traumaassociated with accessing for open surgery. These robotic systems canmove the working ends of the surgical instruments with sufficientdexterity to perform quite intricate surgical tasks, often by pivotingshafts of the instruments at the minimally invasive aperture, sliding ofthe shaft axially through the aperture, rotating of the shaft within theaperture, and/or the like.

In the depicted embodiment, the patient-side unit 100 includes a base110, a first robotic manipulator arm assembly 120, a second roboticmanipulator arm assembly 130, a third robotic manipulator arm assembly140, and a fourth robotic manipulator arm assembly 150. As shown, thebase 110 includes a portion that rests on the floor, a vertical column,and a horizontal boom, and other base configurations to mechanicallyground the patient-side unit may optionally be used. Each roboticmanipulator arm assembly 120, 130, 140, and 150 is pivotably coupled tothe base 110. In some embodiments, fewer than four or more than fourrobotic manipulator arm assemblies may be included as part of thepatient-side unit 100. While in the depicted embodiment the base 110includes casters to allow ease of mobility, in some embodiments thepatient-side unit 100 is fixedly mounted to a floor, ceiling, operatingtable, structural framework, or the like.

In a typical application, two of the robotic manipulator arm assemblies120, 130, 140, or 150 hold surgical instruments and a third holds astereo endoscope. The remaining robotic manipulator arm assembly isavailable so that another instrument may be introduced at the work site.Alternatively, the remaining robotic manipulator arm assembly may beused for introducing a second endoscope or another image capturingdevice, such as an ultrasound transducer, to the work site.

Each of the robotic manipulator arm assemblies 120, 130, 140, and 150 isconventionally formed of links that are coupled together and manipulatedthrough actuatable joints. Each of the robotic manipulator armassemblies 120, 130, 140, and 150 includes a setup arm and a devicemanipulator. The setup arm positions its held device so that a pivotpoint occurs at its entry aperture into the patient. The devicemanipulator may then manipulate its held device (tool; surgicalinstrument) so that it may be pivoted about the pivot point, insertedinto and retracted out of the entry aperture, and rotated about itsshaft axis.

In the depicted embodiment, the surgeon console 40 includes a stereovision display 45 so that the user may view the surgical work site instereo vision from images captured by the stereoscopic camera of thepatient-side cart 100. Left and right eyepieces 46 and 47 are providedin the stereo vision display 45 so that the user may view left and rightdisplay screens inside the display 45 respectively with the user’s leftand right eyes. While viewing typically an image of the surgical site ona suitable viewer or display, the surgeon performs the surgicalprocedures on the patient by manipulating master control input devices,which in turn control the motion of robotic instruments.

The surgeon console 40 also includes left and right input devices 41, 42that the user may grasp respectively with his/her left and right handsto manipulate devices (e.g., surgical instruments) being held by therobotic manipulator arm assemblies 120, 130, 140, and 150 of thepatient-side cart 100 in preferably six degrees-of-freedom (“DOF”). Footpedals 44 with toe and heel controls are provided on the surgeon console40 so the user may control movement and/or actuation of devicesassociated with the foot pedals. Additional input to the system may bemade via one or more other inputs, such as buttons, touch pads, voice,and the like, as illustrated by input 49.

A processor 43 is provided in the surgeon console 40 for control andother purposes. The processor 43 performs various functions in themedical robotic system. One function performed by processor 43 is totranslate and transfer the mechanical motion of input devices 41, 42 toactuate their respective joints in their associated robotic manipulatorarm assemblies 120, 130, 140, and 150 so that the surgeon caneffectively manipulate devices, such as the surgical instruments.Another function of the processor 43 is to implement the methods,cross-coupling control logic, and controllers described herein.

Although described as a processor, it is to be appreciated that theprocessor 43 may be implemented by any combination of hardware,software, and firmware. Also, its functions as described herein may beperformed by one unit or divided up among a number of subunits, each ofwhich may be implemented in turn by any combination of hardware,software, and firmware. Further, although being shown as part of orbeing physically adjacent to the surgeon control unit 40, the processor43 may also be distributed as subunits throughout the telesurgerysystem. Accordingly, control aspects referred to herein are implementedvia processor 43 in either a centralized or distributed form.

Referring also to FIG. 3 , the robotic manipulator arm assemblies 120,130, 140, and 150 can manipulate devices such as surgical instruments toperform minimally invasive surgery. For example, in the depictedarrangement the robotic manipulator arm assembly 120 is pivotablycoupled to an instrument holder 122. A cannula 180 and a surgicalinstrument 200 and are, in turn, releasably coupled to the instrumentholder 122. The cannula 180 is a tubular member that is located at thepatient interface site during a surgery. The cannula 180 defines a lumenin which an elongate shaft 220 of the surgical instrument 200 isslidably disposed. As described further below, in some embodiments thecannula 180 includes a distal end portion with a body wall retractormember.

The instrument holder 122 is pivotably coupled to a distal end of therobotic manipulator arm assembly 120. In some embodiments, the pivotablecoupling between the instrument holder 122 and the distal end of roboticmanipulator arm assembly 120 is a motorized joint that is actuatablefrom the surgeon console 40 and processor 43.

The instrument holder 122 includes an instrument holder frame 124, acannula clamp 126, and an instrument holder carriage 128. In thedepicted embodiment, the cannula clamp 126 is fixed to a distal end ofthe instrument holder frame 124. The cannula clamp 126 can be actuatedto couple with, or to uncouple from, the cannula 180. The instrumentholder carriage 128 is movably coupled to the instrument holder frame124. More particularly, the instrument holder carriage 128 is linearlytranslatable along the instrument holder frame 124. In some embodiments,the movement of the instrument holder carriage 128 along the instrumentholder frame 124 is a motorized, translational movement that isactuatable/controllable by the processor 43.

The surgical instrument 200 includes a transmission assembly 210, theelongate shaft 220, and an end effector 230. The transmission assembly210 is releasably coupleable with the instrument holder carriage 128.The shaft 220 extends distally from the transmission assembly 210. Theend effector 230 is disposed at a distal end of the shaft 220.

The shaft 220 defines a longitudinal axis 222 that is coincident with alongitudinal axis of the cannula 180. As the instrument holder carriage128 translates along the instrument holder frame 124, the elongate shaft220 of the surgical instrument 200 is moved along the longitudinal axis222. In such a manner, the end effector 230 can be inserted and/orretracted from a surgical workspace within the body of a patient.

Also referring to FIG. 4 , another example patient-side system 160 forminimally invasive computer-assisted tele-operated surgery includes afirst robotic manipulator arm assembly 162 and a second roboticmanipulator arm assembly 164 that are each mounted to an operating table10. In some cases, this configuration of patient-side system 160 can beused as an alternative to the patient-side unit 100 of FIG. 1 . Whileonly two robotic manipulator arm assemblies 162 and 164 are depicted, itshould be understood that more than two (e.g., three, four, five, six,and more than six) can be included in some configurations.

In some cases, the operating table 10 may be moved or reconfiguredduring the surgery. For example, in some cases, the operating table 10may be tilted about various axes, raised, lowered, pivoted, rotated, andthe like. In some cases, by manipulating the orientation of theoperating table 10, the clinicians can utilize the effects of gravity toposition internal organs of the patient in positions that facilitateenhanced surgical access. In some cases, such movements of the operatingtable 10 may be integrated as a part of the computer-assistedtele-operated surgery system, and controlled by the system.

Also referring to FIGS. 5-7 , a variety of alternative computer-assistedtele-operated surgical instruments of different types and differing endeffectors 230 may be used, with the instruments of at least some of themanipulators being removed and replaced during a surgical procedure.Several of these end effectors, including, for example, DeBakey Forceps56 i, microforceps 56 ii, and Potts scissors 56 iii include first andsecond end effector elements 56 a, 56 b which pivot relative to eachother so as to define a pair of end effector jaws. Other end effectors,including scalpels and electrocautery probes, have a single end effectorelement. For instruments having end effector jaws, the jaws will oftenbe actuated by squeezing the grip members of input devices 41, 42.

In some cases, the computer-assisted tele-operated surgical instrumentsinclude multiple degrees of freedom such as, but not limited to, roll,pitch, yaw, insertion depth, opening/closing of jaws, actuation ofstaple delivery, activation of electro-cautery, and the like. At leastsome of such degrees of freedom can be actuated by an instrument drivesystem to which the surgical instrument can be selectively coupled.

In some embodiments, the computer-assisted tele-operated surgicalinstruments include end effectors with two individually movablecomponents such as, but not limited to, opposing jaws designed forgrasping or shearing. When a first one of the individually movablecomponents is moved as a second one of the individually movablecomponents remains generally stationary or is moved in an opposingmanner, the end effector can perform useful motions such as opening andclosing for grasping, shearing, releasing, and the like. When the twocomponents are moved synchronously in the same direction, speed anddistance, the resulting motion is a type of pitch or yaw movement of theend effector. Hence, in some surgical instrument embodiments that haveend effectors with two individually movable components, such as jaws,the arrangement can provide two degrees of freedom (e.g., pitch/yawmovements and opening/closing movements).

The elongate shaft 220 allow the end effector 230 and the distal end ofthe shaft 220 to be inserted distally into a surgical worksite through aminimally invasive aperture (via cannula 180), often through a body wall(e.g., abdominal wall) or the like. In some cases, a body wall retractormember on a distal end of the cannula 180 can be used to tent the bodywall, thereby increasing the surgical workspace size. In some cases thesurgical worksite may be insufflated, and movement of the end effectors230 within the patient will often be effected, at least in part, bypivoting of the instruments 200 about the location at which the shaft220 passes through the minimally invasive aperture. In other words, therobotic manipulator arm assemblies 120, 130, 140, and 150 will move thetransmission assembly 210 outside the patient so that the shaft 220extends through a minimally invasive aperture location so as to helpprovide a desired movement of end effector 50. Hence, the roboticmanipulator arm assemblies 120, 130, 140, and 150 will often undergosignificant movement outside patient during a surgical procedure.

Referring to FIG. 8 , an example computer-assisted teleoperated surgerysystem 500 (a “telesurgical system”) is shown in relation to a portionof a simulated patient body wall 20. The system 500 includes the set-upstructure 172, a manipulator device 800, which is an assembly thatincludes a surgical instrument actuator 700, a surgical instrument 600,and a cannula 900.

The set-up structure 172 can be adjustably mounted to a base or frame(i.e., a mechanical ground) such as, but not limited to, a bed rail ofan operating room table. The manipulator device assembly 800 isreleasably and adjustably coupleable with the set-up structure 172. Insome embodiments, the set-up structure 172 and the manipulator deviceassembly 800 can be manually adjusted and then locked into a desiredpose of a multitude of possible poses in relation to the patient’s bodywall 20. For example, the set-up structure 172 and the manipulatordevice assembly 800 can be manually adjusted so that the cannula 900 isaligned with a surgical access location 22. Such adjustments can be madeprior to initiation of a surgery or during a surgery.

The manipulator device assembly 800 includes releasably coupleablecompatible surgical instrument actuator 700 (also referred to herein asa “surgical instrument actuation pod,” or a simply a “pod”). In someembodiments, the pod 700 is readily detachable from the manipulatorassembly 800 such that the pod 700 can be conveniently interchanged withanother pod. The pod 700 defines an insertion axis 702 along which asurgical instrument is inserted and withdrawn. In some embodiments, themanipulator device assembly 800 can rotatably drive an entirety of thepod 700 (and the surgical instrument 600 coupled with the pod 700) torotate at a revolute roll joint about the insertion axis 702 as depictedby arrow 704. Such motion may be referred to as roll motion or simply“roll.”

When the surgical instrument 600 is coupled with the pod 700, a shaft640 of the surgical instrument 600 slidably extends through the cannula900, which is releasably coupled with the manipulator assembly 800. Inuse, the cannula 900 can extend through the body wall 20 of the patientat the surgical access location 22 (which can be defined by a trocar, aport, an incision, a natural body orifice, and the like). The surgicalinstrument 600 includes an end effector 650 that is controlled by thesurgeon performing the computer-assisted teleoperated surgery.

The pod 700 defines a space configured to receive the surgicalinstrument 600. When the surgical instrument 600 is coupled with the pod700, the pod 700 can actuate movements of the end effector 650 and ofthe surgical instrument 600 as a whole. For example, the pod 700 canactuate translational movements of the surgical instrument 600 along thelongitudinal insertion axis 702 of the pod 700. That is, the pod 700 caninsert and retract the surgical instrument 600 deeper (distally) andshallower (proximally) in relation to the patient. Hence, thelongitudinal axis 702 is sometimes also referred to as the insertionaxis 702.

Referring also to FIG. 9 , the example surgical instrument actuator pod700 is shown in isolation from the surgical instrument 600 and themanipulator device assembly 800. The pod 700 includes a proximal end 704and a distal end 706. The proximal and distal ends of the pod 700 definethe longitudinal axis 702 along which a surgical instrument (or otherdevice such as an endoscopic camera) can be installed.

In the depicted embodiment, the pod 700 includes a proximal end plate705, a distal end plate 707, and a housing 710. The housing 710 extendsbetween the proximal end 704 and the distal end 706.

In the depicted embodiment, the proximal end plate 705 is a C-shapedplate, while the distal end plate 707 is a fully circumferential platethat defines an open center. The opening in the proximal end plate 705aligns with a slot opening 712 defined by the housing 710. The slotopening 712 and the opening in the C-shaped proximal end plate 705provide clearance for a handle 612 of the surgical instrument 600 toproject radially from the housing 710 while the surgical instrument 600is coupled with the instrument drive system 700.

In the depicted embodiment, the pod 700 also includes a roll driven gear708. The pod’s roll driven gear 708 is positioned to mesh with and to bedriven by a roll drive gear 847 (refer to FIGS. 10-12 and 16 ) coupledto a roll drive (roll-adjustment) motor 846 (FIG. 11 ) of a third link830 of the manipulator device assembly 800 when the pod 700 is coupledwith the instrument actuator coupling 840 of the manipulator deviceassembly 800. Roll drive gear 847 driven by motor 846 engages rolldriven gear 708, and motor 846 and roll drive gear 847 are illustrativeof various roll drive assemblies that may be used. When the roll drivengear 708 is so driven, the entire pod 700 rotates or rolls (as depictedby arrow 704, FIG. 8 ) about the insertion axis 702. When the surgicalinstrument 600 is engaged with the pod 700, the surgical instrument 600also rotates or rolls about the insertion axis 702 correspondingly asthe roll driven gear 708 is driven by the roll drive gear 847 of theinstrument actuator coupling 840. Accordingly, insertion axis 702 alsofunctions as an instrument roll axis around with elongate shaft 640(FIG. 8 ) rolls.

Referring also to FIGS. 10 and 11 , here a portion of the manipulatordevice assembly 800 is shown in isolation from the other devices of thecomputer-assisted teleoperated surgery system 500. The manipulatordevice assembly 800 includes a first link 810, a second link 820, and athird link 830. The first link 810 and the second link 820 are rotatablycoupled. That is, as described further below, the second link 820 can berotated in relation to the first link 810. The second link 820 and thethird link 830 are rotatably coupled at a pivot. That is, as describedfurther below, the third link 830 can be pivoted in relation to thesecond link 820.

The first link 810 is configured to releasably couple with the set-upstructure 172. Accordingly, in the depicted embodiment the first linkincludes a ball 811 extending from a proximal end of the first link 810.The ball 811 is configured to be received in a socket 173 of the set-upstructure 172. The ball-in-socket connection between the ball 811 andthe socket 173 (a spherical joint) allows for orientation adjustabilitybetween the manipulator device assembly 800 and the set-up structure172. When a desired orientation between the manipulator device 800 andthe set-up structure 172 has been attained, the ball-in-socketconnection between the ball 811 and the socket 173 can be releasablyclamped in a fixed orientation. Thereafter, the first link 810 remainsstationary in relation to the set-up structure 172 until the two areunclamped and readjusted.

The ball-in-socket connection is merely one non-limiting example of thetypes of mechanical connections that can be used between the manipulatordevice assembly 800 and the set-up structure 172. For example,articulating joints, x-y-z adjustment mechanisms, and the like, andcombinations thereof, can be used. The connection between themanipulator device assembly 800 and the set-up structure 172 can bepassive (manually adjustable) or active (power adjustable orpower-assist adjustable).

The third link 830 is configured to releasably couple with the patientbody wall access cannula 900 that is coaxial with the insertion axis702. The cannula 900 defines a lumen that slidably receives the shaft640 of the surgical instrument 600 (or of other devices such as, but notlimited to, an endoscope) along the insertion axis 702. As shown in FIG.8 , the cannula 900 extends distally from the third link 830 through thepatient’s body wall 20 via the surgical access location 22.

As described further herein, in order to facilitate movements of thesurgical instrument 600 (and of the end effector 650 in particular), therelative configuration of the links 810, 820, and 830 of the manipulatordevice assembly 800 actively adjust in response to input (e.g., surgeoninput using the surgeon console 40 and processor 43 as described inreference to FIG. 2 ). It can be said, therefore, that the manipulatordevice assembly 800 is configured to actuate pitch, roll, and yawmotions of the surgical instrument 600 as a whole in response toactuation input. Moreover, as described further herein, the manipulatordevice assembly 800 is configured to actuate such pitch, roll, and yawmotions of the surgical instrument 600 without creating excessivelateral motion of the body wall access cannula 900, which might tend tostress or tear the tissues adjacent the surgical access location 22 orto enlarge the access site inadvertently.

In the depicted embodiment, the manipulator device assembly 800 isdesigned with a hardware-constrained remote center of motion (RCM) 902so that pitch, roll, and yaw motions of the surgical instrument 600 as awhole can be implemented by the manipulator device 800 without creatingexcessive lateral motion of the body wall access cannula 900. The RCM902 is a point in space around which the roll, pitch, and yaw motionsdescribed above are made. In the depicted embodiment, the RCM 902 is apoint on the insertion axis 702 that is fixed at a particularlongitudinal position along the cannula 900. As the relativeconfiguration of the links 810, 820, and 830 of the manipulator deviceassembly 800 actively adjust in response to user input, the RCM 902remains fixed in space. Therefore, while pitch, roll, and yaw motions ofthe surgical instrument 600 as a whole are implemented by themanipulator device 800, excessive lateral motion of the body wall accesscannula 900 that might tend to stress or tear the tissues adjacent thesurgical access location 22 or to enlarge the access site inadvertentlyis avoided. In some embodiments, the RCM can be located at other points(e.g., at a particular distance away from the insertion axis 702). Insome embodiments, the manipulator device assembly 800 can be implementedusing a software-constrained RCM rather than, or in addition to, ahardware-constrained RCM.

Referring to FIGS. 10-13 , it can be seen that first link 810 has aproximal end 810 a and a distal end 810 b. First link 810’s straightlongitudinal axis 821 extends through and is defined by its proximal anddistal ends. It can further be seen that second link 820 has a proximalend 820 a and a distal end 820 b. Second link 820 also has an actuatorhousing portion 820 c that extends proximally beyond proximal end 820 ato a proximal actuator housing portion end 820 d.

Still referring to FIGS. 10-13 , the distal end 810 b of first link 810is rotatably coupled to the proximal end 820 a of second link 820 at arevolute joint 815. The axis of rotation of revolute joint 815 defines alongitudinal axis of second link 820. The longitudinal axes of the firstand second links are coincident, and these coincident axes areillustrated by axis 821 as shown. Accordingly, the second link 820 canrotate in relation to the first link 810 about an axis that is definedby the rotary joint 815, which may be considered a yaw joint (the term“yaw” is arbitrary and does not indicate a unique coordinate system). Itcan be seen that as second link 820 rotates in relation to first link810, second link 820’s housing portion 820 c and its distal end 820 dorbit around first link 810. It can further be seen that an axis throughhousing portion proximal end 820 d and second link distal end 820 bsweeps along a section of a conical surface having an axis coincidentwith the longitudinal axis of second link 820.

The second link 820 is rotatably coupled to the third link 830 at arevolute pivot joint 825, which may be considered a pitch joint (theterm “pitch” is arbitrary and does not indicate a unique coordinatesystem). Accordingly, the third link 830 can pivot in relation to thesecond link 820 about an axis that is defined by the revolute pivotjoint 825. At any combination of relative orientation between the links810, 820, and 830 and motions of the links 810, 820, and 830, the RCM902 remains fixed in space because of the manipulator device assembly800 is designed with a hardware-constrained RCM.

Referring to FIGS. 12 and 13 , here the first link 810 is showntransparently so that the mechanisms by which the second link 820 isrotatable in relation to the first link 810 can be visualized. In thedepicted embodiment, a motor 812 is included in the first link 810. Adrive gear 814 is fixed to the drive shaft of the motor 812. Rotation ofthe motor 812 therefore rotates the drive gear 814. As shown, motor 812extends proximally from drive gear 814 (i.e., proximally from joint815).

The drive gear 814 is meshed with a driven gear 822. The driven gear 822is fixed to the second link 820. Therefore, rotary motion of the drivengear 822 result in corresponding rotary motion of the second link 820.Motor 812 and drive gear 814 are illustrative of various yaw driveassemblies that may be used. As shown, with reference to first link820’s longitudinal axis 821, motor 812’s axis of rotation isnon-parallel, nonintersecting, and at a shallow acute angle. In otherimplementations motor 812’s axis of rotation may, for example, parallelto or coincident with longitudinal axis 821.

Because the first link 810 is constrained in relation to a set-upstructure (e.g., set-up structure 172, FIG. 8 ), rotation of the drivegear 814 causes the driven gear 822 to rotate around its axis 821.Because the driven gear 822 is fixed to the second link 820, rotation ofthe driven gear around the axis 821 causes the entire second link 820 torotate about the axis 821.

The first link 810 also includes a bearing 816. The outer race of thebearing 816 is captured in a stationary relationship to the housing ofthe first link 810. The inner race of the bearing 816 is coupled with astub shaft (projecting from the second link 820) that the driven gear822 is also coupled to. Therefore, the entire second link 820 rotates inrelation to the first link 810 about the axis 821 as the motor 812 isactuated. In the depicted embodiment, the axis 821 is defined by thebearing 816 and is coaxial with the driven gear 822. The axis 821projects through the RCM 902 (FIGS. 10 and 11 ) and functions as aninstrument yaw axis of the manipulator assembly.

Referring also to FIGS. 14 and 15 , here the manipulator device assembly800 is shown in relation to a simulated portion of a patient’s body wall20. The difference between FIG. 14 and FIG. 15 is the rotationalorientation of the second link 820 in relation to the first link 810. Asdescribed above, the second link 820 is rotatable in relation to thefirst link 810 about the axis 821 as depicted by arrow 804. In somecases, the axis 821 may also be referred to as the yaw axis 821, androtations of the second link 820 in relation to the first link 810 maybe referred to as yaw motions, or simply “yaw.” The yaw axis 821projects through the RCM 902.

One advantageous feature of the manipulator device assembly 800 is thatit is designed to facilitate a wide range of yaw motion withoutcontacting the patient’s body (e.g., without contacting a surface 23,which may be a skin surface, for example, or without intersecting aplane that includes the RCM 902 and that is perpendicular to theinstrument insertion axis 702). In general, yaw range of motion islimited by second link 820’s proximity to surface 23 at one extreme (seee.g., FIG. 15 ) and third link 830’s proximity to surface 23 at theother extreme (see e.g., FIG. 14 ). For example, in some embodiments thesecond link 820 can be rotated in relation to the first link 810 throughan arc (as depicted by arrow 804) that is in a range of about 90° toabout 110° (100° ±10°), or about 100° to about 120° (110° ±10°), orabout 110° to about 130° (120° ±10°), or about 120° to about 140° (130°±10°), or about 130° to about 150° (140° ±10°), or about 110° to about120° (115° ±5°), or about 115° to about 125° (120° ±5°), or about 120°to about 130° (125° ±5°) without contacting the patient’s body and/orwithout intersecting the plane that includes the RCM 902. It should alsobe understood that these ranges of rotational motion of the second link820 in relation to the first link 810 can be realized throughout allpossible rotational orientations of the third link 830 in relation tothe second link 820 when pivoted at pivot joint 825.

Another advantageous feature of the manipulator device assembly 800 isits operative usability for computer-assisted teleoperated surgery whilepositioned at a low angle in relation to the surface 23. Such low-anglepositioning can provide advantages such as enhanced patient access bythe surgical team, greater visualization of the patient, and facilitatedcommunications between the surgical team members because they can moreeasily see each other. For example, in some embodiments the manipulatordevice assembly 800 can be oriented such that the angle between the yawaxis 821 and the surface 23 (or, for example, between the yaw axis 821and a plane that includes the RCM 902) is in a range between about 10°to about 30° (20° ±10°), or about 20° to about 40° (30° ±10°), or about30° to about 50° (40° ±10°), or about 15° to about 25° (20° ±5°), orabout 20° to about 30° (25° ±5°), or about 25° to about 35° (30° ±5°),or about 30° to about 40° (35° ±5°). Moreover, the manipulator deviceassembly 800 can be oriented at these low angles while also allowing forthe second link 820 to be rotated in relation to the first link 810through the arc ranges described above without intersecting thepatient’s body (or intersecting the plane that includes the RCM 902).

Referring to FIGS. 16 and 17 , the second link 820 is showntransparently so that the mechanisms by which the third link 830 isrotatable in relation to the second link 820 can be visualized. In thedepicted embodiment, a motor 824 is included in the second link 820. Alead screw 826 is coupled to the drive shaft of the motor 824. Rotationof the motor 824 therefore rotates the lead screw 826.

A nut 828 is threadably coupled to the lead screw 826. The nut 828 isconstrained from rotating in relation to the housing of the second link820. Therefore, as the motor 824 drives rotation of the lead screw 826,the nut 828 is caused to translate along the longitudinal axis of thelead screw 826.

A pitch drive link 829 has a first end that is pivotably coupled to thenut 828 and a second end that is pivotably coupled to the third link 830at a pivot joint 832. The pivot joint 832 is spaced apart from the pivotjoint 825. Therefore, as the motor 824 drives rotation of the lead screw826, the nut 828 is caused to translate along the longitudinal axis ofthe lead screw 826, and the link 829 causes the third link 830 to pivotabout the pivot joint 825 in relation to the second link 820. Thepivoting motion of the third link 830 in relation to the second link 820is depicted by arrow 806. The entire third link 830 pivots in relationto second link 820 about the axis 831 as the motor 824 is actuated. Inthe depicted embodiment, the axis 831 is defined by the pivot joint 825(which acts as a hinge between the second link 820 and the third link830). The axis 831 projects through the RCM 902 and functions as aninstrument pitch axis of the manipulator assembly.

The motor 824, lead screw 826, and nut 828 are illustrative of variouslinear actuators that may be used, including ball screw, chain, belt,hydraulic, pneumatic, electromagnetic, and the like. Such linearactuators and the pitch drive link 829 are illustrative of various pitchdrive assemblies that may be used to rotate third link 830 around pitchaxis 831.

It should be understood that in the context of manipulator deviceassembly 800, the rotational motion between the first link 810 and thesecond link 820 is a different type of motion than the rotational motionbetween the second link 820 and the third link 830. The third link 830pivots in relation to the second link 820 because the links areconjoined at the pivot joint 825 (which acts like a hinge), and so thirdlink 830 generally orbits around axis 831. The second link 820 rotatesin relation to the first link 810 because the links are conjoined at therotary joint 815 which allows the second link 820 to rotate in relationto the first link 810 generally in-line around axis 821.

Referring also to FIGS. 18 and 19 , the manipulator device assembly 800is shown in relation to a simulated portion of a patient’s body wall 20.The difference between FIG. 18 and FIG. 19 is the rotational orientationof the third link 830 in relation to the second link 820. As describedabove, the third link 830 is pivotable in relation to the second link820 about the axis 831, as depicted by arrow 806. In some cases, theaxis 831 may also be referred to as the pitch axis 831, and pivotalmotions of the third link 830 in relation to the second link 820 may bereferred to as pitch motions, or simply “pitch.” The pitch axis 831projects through the RCM 902.

In the depicted embodiment, the pitch axis 831 is non-orthogonal to theinsertion axis 702. The pitch axis 831 remains non-orthogonal to theinsertion axis 702 throughout all rotational orientations of the secondlink 820 around yaw axis 821 in relation to the first link 810,throughout all rotational orientations of the third link 830 aroundpitch axis 831 in relation to the second link 820, and throughout allcombinations thereof. In some embodiments, the angle between the pitchaxis 831 and the insertion axis 702 is in a range between about 10° toabout 30°, or about 20° to about 40°, or about 30° to about 50°, orabout 15° to about 25°, or about 20° to about 25, or about 25° to about35°, or about 30° to about 40°, or about 25° to about 30°, or about 30°to about 35°.

It can be seen that as the third link 830 pivots in relation to thesecond link 820, insertion axis 702 sweeps across a portion of a conicalsurface having an apex at RCM 902. It can also be seen that at a uniquerotational orientation of the third link 830 around the pitch axis 831with reference to the second link 820, instrument insertion axis 702will be perpendicular to yaw axis 821. And so at this unique rotationalorientation around pitch axis 831, rotation of the second link 820around yaw axis 821 with reference to the first link 810 sweeps theinstrument insertion axis 702 across a circular sector surface having acenter at RCM 902. It can also be seen that at rotational orientationsof the third link 830 around the pitch axis 831 with reference to thesecond link 820 other than this unique rotational orientation aroundpitch axis 831, rotation of the second link 820 around the yaw axis 821with reference to the first link 810 sweeps the instrument insertionaxis 702 across a portion of a conical surface having an apex at RCM902. The portions of the conical surfaces across which instrumentinsertion axis 702 is swept by rotation around the yaw axis 821 androtation around the pitch axis 831 are different from each other.

Thus it can be seen that RCM 902 is constrained by manipulator deviceassembly 800’s hardware, and it is defined by the intersection ofinsertion axis 702, yaw axis 821, and pitch axis 831. As the surgeoncommands the instrument end effector 650 to move in various directionsat the surgical site by moving a master input device 42, the controllerillustrated by processor 43 correspondingly controls rotation of theinstrument as a whole along axis 702, around axis 821, and around axis831 to place the end effector at the desired position in space at thesurgical site. Similarly, the controller controls orientation of endeffector 650 by controlling rotation around axis 702, and by moving theend effector in pitch and yaw with reference to instrument shaft 640.Manipulator device assembly 800 provides a compact, low profile, largerange of motion teleoperated manipulator for use during telesurgery.

In some embodiments, the manipulator device assembly 800 may includeelectronic sensors and the like for various advantageous purposes. Forexample, encoders may be coupled to the drive trains of the motorizedpitch, roll, and/or yaw drive (adjustment) mechanisms. In someembodiments, position sensors may be used that can positively identifythe locations of the movable components of the manipulator device 800.

While this specification contains many specific implementation details,these should not be construed as limitations on the scope of anyinvention or of what may be claimed, but rather as descriptions offeatures that may be specific to particular embodiments of particularinventions. Certain features that are described in this specification inthe context of separate embodiments can also be implemented incombination in a single embodiment. Conversely, various features thatare described in the context of a single embodiment can also beimplemented in multiple embodiments separately or in any suitablesubcombination. Moreover, although features may be described herein asacting in certain combinations and even initially claimed as such, oneor more features from a claimed combination can in some cases be excisedfrom the combination, and the claimed combination may be directed to asubcombination or variation of a subcombination.

Similarly, while operations are depicted in the drawings in a particularorder, this should not be understood as requiring that such operationsbe performed in the particular order shown or in sequential order, orthat all illustrated operations be performed, to achieve desirableresults. In certain circumstances, multitasking and parallel processingmay be advantageous. Moreover, the separation of various system modulesand components in the embodiments described herein should not beunderstood as requiring such separation in all embodiments, and itshould be understood that the described program components and systemscan generally be integrated together in a single product or packagedinto multiple products.

Particular embodiments of the subject matter have been described. Otherembodiments are within the scope of the following claims. For example,the actions recited in the claims can be performed in a different orderand still achieve desirable results. As one example, the processesdepicted in the accompanying figures do not necessarily require theparticular order shown, or sequential order, to achieve desirableresults. In certain implementations, multitasking and parallelprocessing may be advantageous.

We claim:
 1. A teleoperated surgical system comprising: a first link; asecond link rotatably coupled to the first link at a revolute yaw jointhaving an axis of rotation that defines an instrument yaw axis; and athird link rotatably coupled to the second link at a revolute pitchjoint having an axis of rotation that defines a pitch axis, the thirdlink defining an instrument insertion axis, wherein the yaw axis, thepitch axis, and the instrument insertion axis intersect at a remotecenter of motion, and wherein rotation of the third link around thepitch axis with reference to the second link sweeps the instrumentinsertion axis to trace a portion of a first conical shape having anapex at the remote center of motion.
 2. The teleoperated surgical systemof claim 1, wherein the first link comprises a proximal end, a distalend, and a longitudinal axis defined between the proximal and distalends of the first link.
 3. The teleoperated surgical system of claim 2,wherein the instrument yaw axis is coincident with the longitudinal axisof the first link.
 4. The teleoperated surgical system of claim 1,further comprising a surgical instrument actuator comprising a proximalend, a distal end, and an instrument insertion axis defined between theproximal and distal ends of the instrument actuator.
 5. The teleoperatedsurgical system of claim 4, wherein the surgical instrument actuator iscoupled to the third link at the distal end of the surgical instrumentactuator.
 6. The teleoperated surgical system of claim 4, wherein thesurgical instrument actuator is releasably coupled to and is readilydetachable from the third link such that the surgical instrumentactuator can be interchanged with a second surgical instrument actuator.7. The teleoperated surgical system of claim 4, further comprising arevolute roll joint, wherein the surgical instrument actuator is coupledto the third link via the roll joint, the roll joint defines an axis ofrotation coincident with the instrument insertion axis, and the surgicalinstrument actuator rotates at the roll joint with reference to thethird link around the instrument insertion axis.
 8. The teleoperatedsurgical system of claim 4, further comprising a roll drive assemblycoupled to the third link, wherein the roll drive assembly is engagedwith the surgical instrument actuator and drives rotation of thesurgical instrument actuator around the instrument insertion axis. 9.The teleoperated surgical system of claim 4, further comprising a usercontrol unit comprising a user input device and a controller, whereinthe first link, the second link, the third link, and the surgicalinstrument actuator together comprise a teleoperated surgicalmanipulator, and wherein user inputs at the user input deviceteleoperate the manipulator via the controller to move a surgicalinstrument with reference to the yaw axis, the pitch axis, and theinstrument insertion axis.
 10. The teleoperated surgical system of claim1, wherein the yaw axis, the pitch axis, and the instrument insertionaxis are retained in movable orientations relative to each other. 11.The teleoperated surgical system of claim 1, wherein at a particularfirst rotational orientation of the third link around the pitch axiswith reference to the second link, rotation of the second link aroundthe yaw axis with reference to the first link sweeps the instrumentinsertion axis across a circular sector surface having a center at theremote center of motion.
 12. The teleoperated surgical system of claim1, wherein at rotational orientations of the third link around the pitchaxis with reference to the second link other than the first rotationalorientation, rotation of the second link around the yaw axis withreference to the first link sweeps the instrument insertion axis totrace a second conical shape having an apex at the remote center ofmotion.
 13. The teleoperated surgical system of claim 1, wherein: thesecond link comprises a pitch drive assembly; the pitch drive assemblycomprises a linear actuator and a pitch drive link coupled to the linearactuator; and the pitch drive assembly is coupled between the secondlink and the third link and drives rotation of the third link around thepitch axis.
 14. The teleoperated surgical system of claim 1, furthercomprising a yaw drive assembly coupled to the second link, wherein theyaw drive assembly is engaged with the first link and drives rotation ofthe second link around the yaw axis.
 15. The teleoperated surgicalsystem of claim 1, wherein the teleoperated surgical system isconfigured to have a range of motion around the yaw axis of at least140° during surgery.
 16. The teleoperated surgical system of claim 1,wherein the teleoperated surgical system is configured to operate duringsurgery with the yaw axis at 10° with reference to a plane defined bythe remote center of motion and a plane perpendicular to the instrumentinsertion axis.
 17. The teleoperated surgical system of claim 1, whereinthe first link comprises a proximal end, a distal end, and alongitudinal axis defined between the proximal and distal ends of thefirst link, and wherein the proximal end of the first link is configuredto couple with a non-teleoperated setup structure.
 18. The teleoperatedsurgical system of claim 1, wherein the third link is configured toremovably couple with an instrument cannula aligned with the insertionaxis.
 19. The teleoperated surgical system of claim 1, furthercomprising a setup structure having a proximal end and a distal end,wherein the distal end of the setup structure is directly coupled to theproximal end of the first link, and wherein the proximal end of thesetup structure is directly coupled to a mechanical ground.
 20. Theteleoperated surgical system of claim 19, wherein the mechanical groundcomprises an operating room table.